1. Field of the Invention
The present invention relates generally to a method and device for use in abdominal surgery; and, more particularly, to a method and device for protecting the umbilicus during abdominal subcutaneous surgery.
2. Description of Related Art
In recent years elective cosmetic surgery has become more prevalent. With the constant pressure on society to look and act younger, plastic surgeons and dermatologists have derived many youth enhancing medical procedures. For example, removing wrinkles, breast augmentation, liposuction to remove excessive fat, and the like has come into accepted vogue. Although these procedures are usually relatively risk free, complications can cause sever medical problems and even, in some cases, death. Among these complications are infections, skin loss, blood loss, strangulation of circulation, and the like.
Some of these elective procedures are relatively simple and require little patient preparation and are relatively risk free. Examples are Botox® injections, skin peels, certain laser procedures, and the like. These procedures are usually preformed in the physician's office or a clinic, on an outpatient basis; and, are accompanied by minor discomfort and pain. Other elective procedures, however, involve major invasive surgery, requiring general anesthesia, hospitalization, and a rather extended recovery period. Face-lifts, some extensive liposuction, and breast augmentation are among those procedures. Procedures such as these and some others involve extensive subcutaneous invasion, blood loss, extended operating room time, pain management, and an extensive recovery period.
Recently even more radical procedures have been introduced to affect cosmetic appearance. Women, especially after childbirth, develop abdominal disfigurement, such as stretch marks, excessive skin sagging, and the like. In addition, the abdomen, which contains substantial fat cells, tends to enlarge with weight gain disproportionately to the remainder of the anatomy in both men and women. Further, with dramatic weight loss, the abdomen skin cannot return to its former “stretched” configuration, resulting in skin folds or sagging at the lower abdomen. In order to deal with this problem, a procedure known as abdominoplasty, commonly referred to as a “tummy tuck,” has been developed.
Abdominoplasty involves the removal of excess skin and fat from the middle and lower abdomen as well as tightening of the abdominal (rectus) muscles. More specifically, this operation is done to tighten the loose skin of the abdomen and repair the weak muscles of the abdominal wall. The procedure is sometimes combined with liposuction to, for example, remove fat, smooth the edges, and improve the contour. If the patient suffers from obesity the panniculus of fat is removed at the same time.
Although abdominoplasty varies, and can even be accomplished, in some cases, by endoscopic methods, the basic procedure for a, so-called, “complete abdominoplasty” is the same. First, a lower abdomen incision is made. The abdominal flap is then lifted and the underlying fat is removed to the abdominal fascia. The abdominal wall muscles are tightened by suturing, the flap is stretched with the excess being removed, and then sutured, preferably below the panty line. The procedure can be “complete” or “partial (mini).” A partial abdominoplasty may take as little as an hour or two, while the complete abdominoplasty takes between two to five hours, depending on the extent of work required.
In a partial abdominoplasty, a short incision is made, and the removal of the umbilicus (umbiliplasty) is usually not required. The skin is then separated only between the incision line and the umbilicus. This abdominal flap is stretched down, while any excess skin is removed. Finally, the abdominal flap is then stitched back into place. In partial abdominoplasty significant strides have been made in surgical procedure using endoscopic assisted methods. One such procedure is disclosed in U.S. Pat. No. 5,655,544 issued in August 1997 to G. W. Johnson. In accordance with this method, the use of abdominal incisions is minimized leaving substantially no visible scars on the abdomen of the patient.
The endoscope assisted abdominoplasty uses two small hidden incisions, one in the umbilicus or on the abdomen or in pre-existing scars or other areas (such as under the armpit) for introduction of the surgical instruments, and a small incision within the pubic hair line for endoscopic and/or direct observation and control of the procedure. While observing the procedure through the endoscope, the surgical instruments are inserted through the umbilical incision to remove fat by liposuction and plicate and repair the muscles by use of a tenaculum and fascial sutures. After removal of the instruments, the small incisions are sutured, and the skin layer allowed to retract and tighten.
While these procedures have met with a modicum of success, they do not lend themselves to a “complete” abdominoplasty. This is primarily due to the fact that a complete abdominoplasty usually requires an umbilicoplasty (repositioning of the umbilicus (belly button)). The complete procedure involves making a long incision from one hipbone to the other above the pubic area. A second incision is made to free the navel from surrounding tissue (circum umbilical pedicle dissection). Next, the skin and subcutaneous fat (abdominal flap) are separated from the abdominal wall to reveal the vertical abdominal muscles (rectus) for tightening. This tightening provides a firmer abdominal wall and helps to narrow the waistline. The abdominal flap is then stretched down and extra skin is removed. A new orifice (belly button hole) is cut for the umbilicus, which is then stitched into place. Finally, the incisions are stitched, dressings are applied, and any excess fluids are drained from the surgical site.
Full or complete abdominoplasty, although an invasive procedure, is routinely performed in hospitals and clinics through out the world. Even though, this procedure has become more or less routine it is fraught with a number of potential complications. Some of the more serious complications relate to the umbilicus (belly button). The umbilicus and umbilical pedicle, to which the umbilical cord was originally attached, is connected to the abdominal fascia tissue and muscle and cannot be repositioned when the epidermis (skin) is repositioned. In order to remove the abdominal flap, remove underlying fatty tissue, and stretch the remaining tissue over the abdomen to remove excess skin, the orifice (belly button opening) must be repositioned to accommodate the umbilical pedicle, which does not move. Thus, when the abdominal flap is stretched and repositioned, a new opening in the abdominal flap is required to access the umbilicus.
In order to accomplish this during complete abdominoplasty, the umbilicus must be cut from the surrounding skin by performing a circum umbilical pedicle dissection. Then, scissors are used to dissect the umbilical stalk from the surrounding fat and tissue down to the muscle fascia. The possibility for nicking or cutting the umbilical stalk during this procedure is substantial.
Then an incision is made along the lower abdomen to facilitate lifting the abdominal flap from the abdomen to “defatten” the abdomen. This dissection is accomplished using, for example, a scalpel and/or electrocautery blade. The possibility for nicking, cutting, or even amputation of the umbilical pedicle during this procedure is substantial. Next, suturing on the midline (rectus abdominis musculoaponeurotic plication) tightens the abdominal fascia muscle. Umbilical pedicle strangulation can occur during this suturing of the abdominal muscles. The separated abdominal flap is then stretched over the defattened abdomen and the access skin trimmed. A new belly button orifice is then cut into the skin after it is stretched and trimmed. Reinserting the umbilicus in the new orifice can also lead to complications such as strangulation, caused by twisting the umbilical pedicle. Sutures are then placed at the incision line to hold the umbilicus, as well as the stretched abdominal flap over the defattened abdomen.
Thus, the complete procedure is somewhat risky using this prior art technique. First, the umbilical pedicle can be cut or nicked during circum umbilical stalk dissection. Thus, there is possible blood supply damage to the umbilicus. Further, since defattening is accomplished under the skin, using a surgical blade, too much tissue may be removed while performing undermining of the flap resulting in nicking, cutting, or amputating the umbilical pedicle. Additionally, once the umbilical pedicle is released from the skin hooks (as described below); it must be re-determined prior to cutting a new orifice. It is difficult to determine the correct umbilicus location under the subcutaneous fat layer for new umbilicus positioning during umbilicus transposition (cutting a new belly button hole and palpating the umbilicus through the skin opening). Twisting of the umbilical pedicle can occur during umbilicus transposition (placement into a new opening in abdomen skin) resulting in strangulation.
Therefore, it would be advantageous to have a device and method for facilitating umbilicus positioning during abdominal surgery and especially plastic reconstructive and aesthetic surgery requiring umbilicoplasty and umbilical stalk transposition. It would be further advantageous to have a device, which prevents nicks, or cuts of the umbilicus during defattening, and assuring proper positioning of the opening during umbilicoplasty and umbilical stalk transposition as well as elimination of umbilical stalk strangulation.